Associations between disordered eating behaviour, diabetes distress and emotion regulation strategies in adults with type 1 diabetes: Results from a Dutch‐Italian cross‐sectional study

Abstract

Aims: Disordered eating behaviour (DEB) and diabetes distress are prevalent in adults with type 1 diabetes (T1D). Emotion regulation strategies, such as cognitive reappraisal and expressive suppression, are associated with DEB and managing stress in general. Here we examine the associations between DEB, diabetes distress, and emotion regulation strategies in the context of T1D.Methods: Adults with T1D in The Netherlands and Italy completed an online survey, covering DEB (DEPS-R), diabetes distress (PAID-5), and emotion regulation strategies (ERQ). Associations between DEB, diabetes distress, and emotion regulation strategies were examined using path analysis.Results: N = 291 participants completed the survey (78.9% women, 39 ± 13 years, HbA 1c : 55 ± 16 mmol/mol (7.2% [3.6%]); TIR: 66% ± 25). N = 79 participants (27.1%) reported DEB (DEPS-R ≥ 20) and n = 159 participants (54.6%) reported elevated diabetes distress (PAID-5 ≥ 8). The path analysis, with small-to-medium effect sizes, revealed that more diabetes distress was associated with more DEB (β = 0.23, 95% CI [0.13, 0.34]). Less diabetes distress was associated with more use of cognitive reappraisal (β = −0.24, 95% CI [−0.36, −0.12]). More DEB was associated with more use of expressive suppression (β = 0.14, 95% CI [0.04, 0.24]). Conclusions:This cross-sectional study suggests an association between DEB and diabetes distress, between cognitive reappraisal and less diabetes distress and between expressive suppression and more DEB. The results suggest that it may prove beneficial to prioritize strengthening emotion regulation strategies in interventions for people with T1D and DEB. Future research should help clarify causality with regard to emotion regulation and DEB in adults with T1D.

Psychometric properties of the Diabetes Eating Problem Survey–Revised among Dutch adults with type 1 diabetes and implications for clinical use

“…This study was part of a larger study on disordered eating and emotion regulation in Dutch and Italian adults with T1D. 5 Only data from the Dutch sample was used for the current study. The Dutch sample was recruited according to a convenience sampling procedure: the study was widely publicized via emails to interested participants of previous studies, websites of diabetes organizations and social media platforms, including Facebook community groups for adults with T1D.…”

“…1,2 Studies have primarily been conducted in adolescents (mainly women) with T1D due to a higher prevalence in this group; however, there is evidence that DEB can present in people living with diabetes of all ages, including men. [3][4][5] Some reasons why people with T1D are more likely to develop DEB than peers without diabetes relate to the fact that (a) people with T1D must always be mindful of their food intake, which can result in rigid thinking about food, weight and body image, 6 (b) hypoglycaemic episodes can cause an insatiable hunger and can trigger binge eating episodes 7 and (c) weight gain brought on by insulin therapy may result in feelings of body dissatisfaction. 8 DEB has been related to a younger age, a higher body mass index (BMI), a higher HbA1c and elevated levels of diabetes distress, [3][4][5] speaking to the clinical relevance of screening and management of DEB, especially in persons with T1D who engage in insulin reduction or omission with the aim of losing weight.…”

“…[3][4][5] Some reasons why people with T1D are more likely to develop DEB than peers without diabetes relate to the fact that (a) people with T1D must always be mindful of their food intake, which can result in rigid thinking about food, weight and body image, 6 (b) hypoglycaemic episodes can cause an insatiable hunger and can trigger binge eating episodes 7 and (c) weight gain brought on by insulin therapy may result in feelings of body dissatisfaction. 8 DEB has been related to a younger age, a higher body mass index (BMI), a higher HbA1c and elevated levels of diabetes distress, [3][4][5] speaking to the clinical relevance of screening and management of DEB, especially in persons with T1D who engage in insulin reduction or omission with the aim of losing weight. 8 The Diabetes Eating Problem Survey-Revised (DEPS-R) was developed for use in people with diabetes to detect DEB, with a recommended cut-off total score of ≥20.…”

The relationship between emotional self-awareness, emotion regulation, and diabetes distress among Italian and Dutch adults with type 1 diabetes

“…This study was part of a larger study on "Eating and Emotions, " a cross-sectional investigation among adults with T1D from the Netherlands and Italy (Embaye et al, 2023). Prior to recruitment, the sample size required to reach the set objective was calculated with the semPower package (Moshagen and Erdfelder, 2016) within the R environment, with a one-sided p < 0.05, a power of 0.80, and an RMSEA of 0.05.…”